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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUTLDER DELCARATION
<br />I hcrby affird on&r pedlry or ncrjury rhar L .remrr lon rllc G)nrrhii Lions llw for lh. folheiry rclsltr (Scc.7rll.5
<br />Busir.ss rnd Prorission Codc): An, Ciiy or County which rcquncs a ltcrmir ro on{tucr. alrcr. improlc, demoli\h or rcpdir My
<br />slrucluE. prhl lo irs hsuorcc, aho rcquirc\ rhc 0pllicinr f.r such lErmir lo fiL " sign.d sarctunr thar hc o. shc is lien(n lurs i
<br />tu lh. ptuvi{iutrs ol th. conlra.ktr s Liccnsd l,s (Ch,prcr 9. ConnncEirlS wilh Scction?000 ol Ditnion I ofrh. Busincs ,nd
<br />Profc$iotrs Codc) or rhat hcorsh. isexcmpr lficreiorrnd lhehost r'o! lnc ullcgcd crcnrrion Anyviolarionors(r6.?0ll5byaot
<br />apili.anr lor a pcdir suhrc.k th. rytlicanr ro r.ivilr.nalryofnormr.rhrn nvc hundrcd dollfr (S5U))
<br />-1.
<br />trs owrerolrhctmFny. ormlcmployces wirhwr8csaslhct solc conpcnsorion. silldo rtE Rort Drl lh. nturm i! mr
<br />inr.nd.n o! ottcr.n for sL lse 7044, Buri&s ud PDfessnnF Code l hc Co.h.tn s Li.cnk tiw docs nol |p!ly lo an owner oi
<br />rh. Jmpcdy who bdilds or irpruvcs ri.mn. oid who drB suh $orr hinscll or h.rslf.r rhrcush nis or hcr oNn chpl.yrcs.
<br />,iovidcd ihar skh i'npn'k'*nr ft nor inrc'idl or ofttEd lo {h li howcwr, rL hriliry or inrrn,vcftnr i! sld *irhin u.c }td
<br />oaomplcrion- ltE O*rcr nuiur *ill hlE thc l,udcn ot rotu lhal lE or she dil mr t ild or nnpmrc dt rn,Fiy ror rh,u4rsor
<br />_l. rsowncroirhc prtiFny. Licr.tu\ivclycontrcrins wirh li.cnscd conrr.kh b.on{ru.r lh pojcd (Scc. r(x4. au\inci\
<br />ntrd Ptuf.\\i)n C:()dc: Thc Conkr.ror's Li.cnsc Lrp docs n.r pply ro M o*ncr ol prot--. ywhohuildsori pnNrsrhcrcotr.
<br />nnd sho conrftcklorsuch rrujcch wirh 4Co racro(9liccnscd pursurtrr rorhcG,ntr.ttr sl-iccn* tjw)
<br />-l
<br />sncicmfl undcr SN'n n-- B &PC fnrrhi\raen
<br />Dare, O*@r:
<br />woRxF Rs- co[rPFNsAT r{lN
<br />IIDIIdAAIIAB
<br />I hcrchy atltnrundcr Fnaltyor pqjur, onc olrhc aollosins dccla.rlions:
<br />lhnlca.rlwill.,uin'JiraCcnirkxrdorCo.icnrroSclflnsurclnrwork...,hpcnsdiotr,a{r,vidcdrorbyScction3T0O.lthc
<br />khor Co!r. tu lhc pclfonurcc or lnc *olt fo, shich thc pc,mil h hsucd
<br />I lrvc ud *illnuinrrii $orkcrr conDr.\rri,nrin{h.rc. r\ rcqtrnrdbyScdninlTiX}.lrhcLrhorCr)dc.lhrrh.pcrtnrromcot
<br />Ihl $ 1\1{ qh}hrhi rc,'rirri. i..u{l Vrsrl.,.'!'nF. Ua{iOur" I lrton €tte
<br />n\rri,rninsu'rnrcuricrx dE)li.ytruith$nrc
<br />r)fr.r,754777 4L 6lo, I 11
<br />l.cniryrhar inthc pcrlanun.coflhc work for shichlhi( pcirnii is hsucd.I shollnor cnrloy!n,pcr$n ii an, 'dnrr$ !sh bccom subj.rt ro rhc *o*.r Nmp.nqrion hws oacalibmia- lnd,aft rhi irl \hould b.coft subAr b llE
<br />workcr comtcnsrliontmvisionsofScctio!]T0Oofrhc Lltnr Codc.l slull- lo hwirh mmily wirh ltk,* Ptuvitions
<br />c i( utrhwrirl. d \hall su r !n cmploycr ro nimi.rl Fnrlrid and
<br />nanu8rs a\ provnlcd ld th.
<br />I hcrcby rin tridcr r.nahy ol NrjLr! rh0r I in hccrscd undd trovhdr ol Chollq 9 (conrnrncin8 $irh Scclion TlXx)) ofDivisn,n l
<br />4za%
<br />/,8
<br />CIIISIBIIIIIINIINDINS.AGDNCI
<br />I h.Eby dmrm undci Fnahy ol !.!ury thol lhcrc h r on(rclion Lndin8 a8cncy lbr thc l,crl'orromc of lh. work ror *hi.h rhis dni is
<br />hsocd (56. lO97- Civ. C.).
<br />AITIICAIfDICLAf,AIII}N
<br />I trrhy !8inn hdcr pcnalryifpcrjury oft orrh. folloqins dech.lri{,na
<br />Dcmolilion Pcrmils'Asbcslos Nolificalion Fcd€rol RcBulalioas ('rnb.10, Prd6)
<br />-Req!ircd
<br />txrrer of NorifElrion
<br />I..nifyrhlrrhc fcdcnl rclul.t.ns rcBidirS $hci.s rc'n.vrl trc nor.fDlicnhlc ro ihh pr.jd
<br />_! ccniiylhar I havc rc rhhapplicrrionu srtrrcrhrr thc irlonndion i\.onrr I rEr.o t,.ou
<br />odi.orEcsaDd Sr.rc tnws rchtiry t l anrlmriT.'cpr.sctrrrriR\.trhi\ C
<br />xM\. trr.nl 1trtl| f,ot,.rrr ror i,tr
<br />rrr$',h"llq(y rl(.rd)
<br />y and c,,u6yh rridur{rrr
<br />?11/ r r
<br />Site-Work
<br />Under ground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER ilurh ?' r,'nln*-,6>
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Floof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinos (T-Bar Rouoh)
<br />lvleter Release
<br />Rouoh 4fu.e|*fi4a/na-I O-.
<br />Service IVleter '!r
<br />I //u//t,V,tnrt-/OZ-
<br />Notes, Remarks, Etc.
<br />of lhc llusi',.\1rnd Pnrc*tnxCo,lc. rl 'nr liccn\c i\ n,l! lknc n cllilr
<br />t ndtr\ Addrcs:
<br />-
<br />Air Conditioners
<br />FINAL
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